Document Type
Article
Publication Date
12-19-2022
Abstract
What was once considered a topic best avoided, managing heart failure with reduced ejection fraction (HFrEF) has become the focus of many drug and device therapies. While the four pillars of guideline-directed medical therapies have successfully reduced heart failure hospitalizations, and some have even impacted cardiovascular mortality in randomized controlled trials (RCTs), patient-reported outcomes have emerged as important endpoints that merit greater emphasis in future studies. The prospect of an oral inotrope seems more probable now as targets for drug therapies have moved from neurohormonal modulation to intracellular mechanisms and direct cardiac myosin stimulation. While we have come a long way in safely providing durable mechanical circulatory support to patients with advanced HFrEF, several percutaneous device therapies have emerged, and many are under investigation. Biomarkers have shown promise in not only improving our ability to diagnose incident heart failure but also our potential to implicate specific pathophysiological pathways. The once forgotten concept of discordance between pressure and volume, the forgotten splanchnic venous and lymphatic compartments, have all emerged as promising targets for diagnosing and treating heart failure in the not-so-distant future. The increase in heart failure-related cardiogenic shock (CS) has revived interest in defining optimal perfusion targets and designing RCTs in CS. Rapid developments in remote monitoring, telemedicine, and artificial intelligence promise to change the face of heart failure care. In this state-of-the-art review, we reminisce about the past, highlight the present, and predict what might be the future of HFrEF therapies.
Recommended Citation
Piña, Iliana L.; Gibson, Gregory T.; Zieroth, Shelley; and Kataria, Rachna, "Reflecting on the Advancements of HFrEF Therapies Over the Last Two Decades and Predicting What Is Yet to Come" (2022). Division of Cardiology Faculty Papers. Paper 124.
https://jdc.jefferson.edu/cardiologyfp/124
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Language
English
Included in
Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Cardiology Commons
Comments
This article is the author's final published version in European Heart Journal Supplements, Volume 24, Issue Supplement_L, December 2022, Pages L2–L9.
The published version is available at https://doi.org/10.1093/eurheartjsupp/suac112. Copyright © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.